New Approaches of the Hyponatremia Treatment in the Elderly – An Update

Abstract

Hyponatremia (hNa) is a frequently common imbalance in the elderly hospitalized patients. It is often correlated with elevated plasma quantities of arginine vasopressin (AVP, the antidiuretic hormone) and namely it depicts a water surplus in order to prevail sodium levels. It can conduct, in a comprehensive range, to detrimental changes that can affect the entire health status, especially the central nervous system, thus increasing the mortality and morbidity of hospitalized patients in care units. The inherent treatment of hNa, mainly of the chronic form, requires the correction of serum sodium concentrations at the appropriate rate, because, augmenting it at a warp speed, it can determine permanent or fatal neurologic sequelae. In this regard, the therapy for hNa may be enlightened by egressing therapies that include vasopressin V2 and V1a receptors antagonists, with the principal role of encouraging aquaresis and rise the serum sodium levels, alongside with the electrolytesparing discharge of free water. RezumatHiponatremia este o afecțiune frecvent întâlnită la pacienții vârstnici. Este asociată adesea cu un nivel plasmatic ridicat de arginină vasopresină (hormon antidiuretic) și adesea, definește excesul de apă în raport cu depozitele de sodiu predominante. Poate determina o serie largă de modificări periculoase, care implică în special sistemul nervos central, crescând morta litatea și morbiditatea pacienților spitalizați. Tratamentul corespunzător al hiponatremiei, în special al formei cronice, implică corectarea concentrațiilor serice de sodiu la un nivel corespunzător, deoarece, în caz contrar, pot să apară sechele neurologice permanente sau fatale. Tratamentul hiponatremiei poate fi facilitat de terapii inovatoare care blochează acțiunile vasopresinei asupra receptorilor vasopresinei V2 și V1a pentru a favoriza excreția apei fără electroliți și a crește concentrațiile serice de sodiu.

Late-Onset Epilepsy in the Elderly: Difficulties of Diagnosis and Personalized Pharmacological Management, With Particularities to Covid-19 Pandemic – Systematic Review of Literature

“…Endogenous and exogenous risk factors for seizures and epilepsy in the elderly. The predisposition to further development of symptomatic convulsions and epilepsy is miscellaneous: systemic and extracerebral disorders (metabolic or electrolyte disturbances, toxic factors, inappropriate administration or sudden discontinuation of psychotropic drugs or within 48 h of cessation of prolonged drinking, hypothyroidism, pneumonia, urosepsis and hepatic failure) [4, 25,32,35]. Many old persons may have dysbiosis of gut microflora and inflammatory bowel disease.…”

“…A wide range of medications commonly used by the elderly have proconvulsant side effects and precipitate drug-induced symptomatic acute seizures: antibiotics such as carbapenems (mero-/; erta-/; imipenem); highdoses of penicillin; antihistamines (desloratadine); pain medication (tramadol or high-dose opiates); initiation or withdrawal of antipsychotics or antidepressants (clomipramine, bupropion); theophylline, Levodopa and even Ginkgo biloba herbal remedies [32]. Antihypertensive, diuretics, some antidepressants, even anti-epileptic drugs (such as carbamazepine (CBZ), or the newer one oxcarbazepine (OXC), particularly when co-administered with diuretics) can induce hyponatremia in the elderly, although this might be asymptomatic [3,4,35]. Sodium concentrations below 125 mmol/L are associated with an increased seizure risk in the elderly [35].…”

“…Antihypertensive, diuretics, some antidepressants, even anti-epileptic drugs (such as carbamazepine (CBZ), or the newer one oxcarbazepine (OXC), particularly when co-administered with diuretics) can induce hyponatremia in the elderly, although this might be asymptomatic [3,4,35]. Sodium concentrations below 125 mmol/L are associated with an increased seizure risk in the elderly [35]. Neurotrophic agents have no active role in epileptogenesis and may be used to treat patients who share epilepsy as a co-morbidity (e.g., elderly epileptic patients with stroke).…”